1. science
2. medicine

[28-04-2015]
FORM OF AGREEMENT
WITH
REGISTERED MEDICAL PRACTITIONERS
FOR PROVISION OF SERVICES
TO CHILDREN UNDER 6 YEARS OLD
PURSUANT TO
THE HEALTH
(GENERAL PRACTITIONER SERVICE)
ACT 2014
(UNDER 6 YEAR OLDS)
RECITALS
A. The Health Service Executive (“HSE”) is a statutory body created by the Health Act, 2004 to manage and deliver,
or arrange to be delivered on its behalf, health and personal social services. Its object is to use the resources
available to it in the most beneficial, effective and efficient manner to improve, promote and protect the health
and welfare of the public. It has the power, subject to its available resources and to any directions from the
Minister for Health, to enter into arrangements with Medical Practitioners for the provision of health or personal
social services on behalf of the HSE. The HSE is entering into this interim agreement with Medical Practitioners for
the provision of GP Services free at the point of use to children aged under 6 years within the context of the
Framework Agreement of June 2014.
B.
The Health (General Practitioner Service) Act 2014 provides the legislative basis for the provision without charge
of a general medical and surgical service to persons aged under 6 years.
C.
The core of the Government Health Reform Programme, as set out in Future Health - A Strategic Framework for
Reform of the Health Service, 2012-2015 is the creation of a single tier health service, and encompassing
universal primary care, with GP care free at the point of use for all.
D. The HSE/Department of Health and the IMO are engaged in a process of negotiations under the Framework
Agreement of June 2014 on a new GMS contract. Pending the completion of negotiations on a new GMS contract
this interim contract, by agreement of the parties thereto, is being offered to suitably qualified Medical
Practitioners in order to facilitate the introduction of GP care free at the point of use to Child Patients.
E.
Health and Wellbeing is a key pillar within the Reform Programme. Healthy Ireland, a Framework for Improved
Health and Wellbeing 2013-2025 provides a framework of action to achieve a greater emphasis on prevention,
early intervention and to support keeping individuals and communities well. Primary Care has a key role to play in
the delivery of these health gains across the population as manifested in the Periodic Assessments.
This interim contract provides an opportunity to commence the process of re-orientating the focus of General
Practice toward prevention and health promotion in addition to diagnosis and treatment. It is well known that the
majority of chronic conditions are related to a small number of lifestyle issues, which if modified could avoid
these conditions. General Practice is centrally positioned to lead this approach.
The population will have access to free GP care, on a phased basis. This will be a key part of the overall reform of
the way healthcare services are delivered in the community, with GPs working in teams with other Primary Care
Professionals focussing on illness prevention and structured care of chronic conditions. Primary Care Teams will
provide the foundation medical and non-medical care that people need, whether it is for health or social needs.
The provision of free GP services for children aged under 6 years represents the first phase in the provision of free
GP care at the point of use for all. This document provides the contractual underpinning for the provision of free
GP care to children aged under 6 years.
F.
The HSE and the Medical Practitioner wish to enter into a contract under which the Medical Practitioner will
provide free General Practitioner Medical and Surgical Services in accordance with the provisions of this
Agreement to persons aged under 6 years.
G. Primary Care Teams and Networks provide the foundation for a new model of integrated care in Ireland. While
progress has been made in the formation of Primary Care Teams, further work needs to be carried out with
General Practice to ensure that Teams are efficient, integrated with General Practice and deployed in a manner
that optimises their potential. The structural and contractual enablement of effective General Practice
participation in Primary Care Teams, while beyond the scope of this interim Agreement, will be the subject of
engagement with the Irish Medical Organisation as part of the wider review of GP contracts which is being carried
out under the Framework Agreement.
H. It is acknowledged that the Services provided pursuant to this Agreement are being provided in the context of an
evolving health service which is in the process of developing new structures and arrangements. The overarching
priority of the Health Service Executive is the provision of effective, safe, high quality health and personal social
services; and this priority is a central theme of Future Health. The National Standards for Safer Better Healthcare
approved by the Minister in June 2011 provide a roadmap for improving the safety, quality and reliability of
healthcare. Both parties are committed to ensuring that the Services provided pursuant to this Agreement reflect
the priority of patient safety and quality. The Medical Practitioner shall take an active approach toward the
assurance of patient safety and the provision of high quality services by ensuring that services are organised and
delivered in accordance with the National Standards for Safer Better Healthcare and underpinned by clinical
effectiveness. Adherence to national clinical guidelines and engagement in clinical audit are key components of
this clinical effectiveness agenda for the Medical Practitioner. This quality improvement approach promotes costeffective healthcare that is evidence-based and consistent.
I.
Children First is Ireland’s National Guidance for the protection and welfare of Children. The aim of Children First is
to promote the safety and well-being of children. Professionals have an important part to play in promoting the
safety and well-being of children. In the above context, both parties are committed to ensuring that the Services
adhere to the principles and objectives of Child Care Legislation and of the Children First National Guidance and
that at all times the safety and welfare of children is paramount.
DEFINITIONS AND INTERPRETATIONS
NOW IT IS HEREBY AGREED AS FOLLOWS:
i.
In this Agreement, the following terms shall have the following meanings unless the context otherwise
provides:
“Agreement” means these terms and conditions, the Schedules and Appendices hereto and, to the
extent applicable, circulars previously agreed by the Department of Health and the Irish Medical
Organisation as part of the GMS contract. In the event of any inconsistency or conflict between the
previously issued circulars and these terms and conditions, precedence shall be given to these terms
and conditions, and in all cases any question of interpretation shall be resolved in a manner that
gives effect to the provisions and stated objectives of these terms and conditions.
“Asthma Cycle of Care” means the provision of an enhanced service to Child Patients with a
diagnosis of Asthma as described in Clause 10.7 and Appendix 2 of this Agreement.
“Authorised Representative” means the person nominated by the HSE to represent it for the
purpose of applying the terms and conditions of this Agreement.
“Business Day” means any day other than Saturdays, Sundays, Public Holidays and Good Friday.
“Child Patients” means persons under the age of 6 who are eligible for general medical and surgical
services pursuant to the provisions of the Health (General Practitioner Service) Act 2014 (or, as the
context may require, the Parent(s)/Guardian(s) of the relevant child).
“Community Pharmacy Contractor” means a pharmacist holding a contract with the HSE for the
provision of Community Pharmacy Services under the Health Act, 1970.
“Director General” means the Director General of the HSE and, save as followed by the words ‘in
person’ includes any employee of the HSE to whom, from time to time, a function of the Director
General has been delegated or sub-delegated in accordance with Section 16H of the Health Service
Executive (Governance) Act 2013.
“Fees” means the fees, subsidies and allowances payable to the Medical Practitioner in accordance
with Clause 17.
“Framework Agreement” means agreement signed between the Department of Health/ HSE and the
th
IMO on 4 of June 2014.
“GP Contracts” means the ‘Agreement with Registered Medical Practitioners for the provision of
services under section 58 of the Health Act, 1970 to persons with full eligibility’ (referred to as the
‘GMS Contract’) and the ‘Agreement with Registered Medical Practitioners for the provision of
service to certain persons with limited eligibility under Section 58 of the Health Act 1970 as amended
by the Health (Amendment) Act, 2005’ (referred to as the ‘GP Visit Card Contract’).
“Health Acts” means the Health Acts 1947 to 2014, as amended.
“Indemnity” means a policy of medical indemnity insurance or other indemnity arrangement against
losses arising from claims in respect of civil liability incurred by a Medical Practitioner in respect of
any act or omission of that Medical Practitioner arising from his/her practice as a Medical
Practitioner.
“Intellectual Property Rights” means patents, copyright, registered and unregistered design rights,
utility models, trade marks (whether or not registered), database rights, rights in know-how and
confidential information and all other intellectual and industrial property rights and similar or
analogous rights existing under the laws of any country, and all rights to apply for or register such
rights.
“Medical Practitioner” means the relevant Medical Practitioner(s) [for this purpose relevant medical
practitioner(s) has the meaning as set out in Section 5. 58C.(12) of the Health (General Practitioner
Service) Act 2014] who has/have entered into this Agreement.
“Memorandum of Understanding” means the Memorandum of Understanding signed between the
th
Department of Health/HSE and the IMO on 25 February 2015.
“Normal Contracted Surgery Hours” mean the 40 hours during which the Medical Practitioner
commits to being available for consultations pursuant to this Agreement, as set out in the Medical
Practitioner’s signed Form of Agreement.
“Normal/Routine Surgery Hours” means all hours the Practice Premises are scheduled to be open,
which may include hours outside of the Normal Contracted Surgery Hours.
“PCRS” means the Primary Care Reimbursement Service.
“Periodic Assessments” means age based preventive checks focused on health and wellbeing and
prevention of disease. The requirements of these Periodic Assessments will be subject to change on
the basis of policy and evidence and any such revisions shall be introduced in accordance with the
Framework Agreement.
“Practice Premises” means the premises meeting the requirements of Clause 12 as specified in the
Medical Practitioner’s Agreement with the HSE.
“Records” means the records required to be created and/or maintained by the Medical Practitioner,
as further described in Clause 14 herein.
“Relevant Representative Bodies” includes the Irish Medical Organisation and such other bodies as
may be recognised by the HSE from time to time as being a representative body of medical
practitioners. For the purposes of this Agreement, consultation with a recognised Representative
Body shall not preclude the HSE from consulting individual Medical Practitioners or other
stakeholders.
“Staff” means all persons (including, without limitation, medical practitioners, employees, agents
and independent contractors) involved in the provision of the Services in accordance with this
Agreement.
“the Minister” means the Minister for Health.
“the Services” means General Practitioner Medical and Surgical Services to be provided by the
Medical Practitioner in accordance with the terms of this Agreement.
ii.
Save as otherwise provided herein, references to clauses and schedules are to those contained in this
Agreement. The schedules form an integral part of this Agreement and reference to this Agreement
includes reference thereto. Headings are inserted for convenience only and do not affect the
construction of this Agreement.
iii.
Unless the context requires otherwise, words in the singular may include the plural and vice versa.
iv.
Words importing the masculine gender shall include the feminine gender and vice versa.
v.
References to any statute, enactment, order, regulation or other similar instrument shall be construed
as a reference to the statute, enactment, order, regulation or instrument as amended or replaced by
any subsequent enactment, modification, order, regulation or instrument. References to any statute,
enactment, order, regulation or other similar instrument shall include reference to any regulations
made thereunder.
vi.
Any performance and compliance obligations imposed on the parties include the obligation to meet
such obligations at their own cost.
vii.
Any obligation on the parties to keep records, data or information includes the obligation to keep
them up to date and accessible.
1 PERSONS FOR WHOM SERVICES WILL BE PROVIDED
1.1
Pursuant to the Health (General Practitioner
Service) Act 2014, the Medical Practitioner
shall provide the Services, or arrange for the
provision of Services, in accordance with this
Agreement for:
1.1.1 All Child Patients whom he/she has
accepted for inclusion on his/her panel
of Child Patients and who have not
been notified to him/her by the HSE as
having ceased to be on his/her panel;
1.1.2 All Child Patients who have been
assigned to him/her by the HSE in
accordance with Clause 3 and who
have not been notified to him/her by
the HSE as having ceased to be on
his/her panel;
1.1.3 All Child Patients who present to
him/her as temporary residents (as
defined in Clause 4);
1.1.4 All Child Patients who present to
him/her for emergency services (as
defined in Clause 5).
2 ACCEPTANCE OF PATIENTS
2.1
The Medical Practitioner shall ordinarily
accept on to his/her panel all Child Patients
who so request. In the event of a Medical
Practitioner not wishing to accept a Child
Patient on to his/her panel, the Medical
Practitioner, where so requested by the HSE,
will give in confidence the reason for his/her
decision to the HSE. Where the HSE is satisfied
that a Child Patient has not succeeded in
obtaining acceptance by a
Medical
Practitioner, the HSE may assign such a person
to a Medical Practitioner in accordance with
the provisions contained in Clause 3.
2.2
While the maintenance of the list of Child
Patients shall remain at all times the
responsibility of the HSE, the Medical
Practitioner shall provide updates to the HSE
of any changes to his/her panel of Child
Patients on account of births, deaths or other
reasons.
3 HSE ASSIGNMENT OF A PATIENT
3.1
Where the application made to register a Child
Patient has been unsuccessful in respect of all
of the Medical Practitioners in the area in
which the Child Patient resides, or at least
three of those Medical Practitioners, the HSE
may assign that Child Patient to a Medical
Practitioner and that Medical Practitioner shall
accept the Child Patient onto his/her panel.
Unless the Director General directs otherwise,
the assignment shall ordinarily be to a Medical
Practitioner who practises in the area in which
the Child Patient resides.
3.2
3.3
4
TEMPORARY RESIDENTS
4.1
5
A Child Patient who moves temporarily to and
is resident in a place not ordinarily served by
the Medical Practitioner on whose panel
he/she is included and who does not, at the
time of his/her arrival in that place, intend to
remain there for a period exceeding three
months, shall be regarded as a temporary
resident. If his/her stay at that place extends
to more than three months, his/her residence
from the end of that period shall cease to be
regarded as temporary.
EMERGENCY TREATMENT
5.1
6
Where an assignment is made to the Medical
Practitioner, he/she may request a review of
the assignment after six months.
Where the Agreement with the Medical
Practitioner has been terminated or
suspended, the HSE may assign Child Patients
on his/her panel to another Medical
Practitioner(s) with the consent of that
practitioner until an agreement has been
made with another Medical Practitioner in
succession to the Medical Practitioner or the
suspension has been terminated, as the case
may be.
The
Medical
Practitioner
accepts
responsibility within reason to provide, when
available, within his/her area of practice,
emergency services for cases arising from
accidents or otherwise, of Child Patients not
on his/her panel where he/she is summoned
to give such services or where the Child
Patient attends at his/her Practice Premises
for such services. No such responsibility shall
arise save where the Child Patient is unable to
receive such treatment at that time from the
Medical Practitioner on whose panel the Child
Patient’s name is included, or from his/her
Deputy.
LIMITATION ON NUMBERS
6.1 The number of Child Patients whose names
may be placed on the panel of the Medical
Practitioner shall not, when aggregated with
the Medical Practitioner’s number of patients
under the GMS Contract and the GP Visit Card
Contract, exceed 2,200 save where the HSE, in
exceptional circumstances, after consultation
with the Irish Medical Organisation decides to
apply a higher limit.
Where the Medical Practitioner holds or
obtains a HSE appointment (i.e. performs a
function for the HSE outside of the terms of
this Agreement or a GP Contract), the HSE
may specify a limit lower than 2,200 for the
total number of patients.
7
8
TRANSFER TO ANOTHER MEDICAL PRACTITIONER
7.1 Where the Parent(s)/Guardian(s) of a Child
Patient no longer wishes the Child Patient to
attend the Medical Practitioner with whom he
/ she is registered, the Parent(s)/Guardian(s)
may seek to have the Child Patient included
on the panel of another Medical Practitioner
by requesting the HSE for a transfer to
another Medical Practitioner and the HSE
shall arrange such transfer as soon as
possible.
9.4
DISCONTINUANCE OF ACCEPTANCE OF A PATIENT
BY THE MEDICAL PRACTITIONER
8.1
9
9.3
Where the Medical Practitioner requests the
HSE to arrange to have a Child Patient (other
than a Patient who has been assigned to
him/her pursuant to Clause 3) removed from
his/her panel, the HSE may ask for the
reasons for such a request, which shall be
provided in confidence by the Medical
Practitioner. The HSE shall thereupon notify
the Parent(s)/Guardian(s) of the Child Patient
and supply them with information to enable
them to apply for inclusion in the panel of
another Medical Practitioner. On the patient
being accepted by, or assigned to, another
Medical Practitioner, his/her name shall be
deleted from the panel of the original Medical
Practitioner and that Medical Practitioner
shall be so notified. The HSE shall arrange for
action under this Clause 8 to be initiated
within seven (7) days and to be completed
with all practical speed. If, after the expiration
of one month from the Medical Practitioner’s
request, the Child Patient’s name has not
been included on the panel of another
Medical Practitioner, the HSE shall, unless
there are substantial grounds for not doing
so, assign him/her to a Medical Practitioner.
AVAILABILITY
9.1
9.2
In line with the objective of ensuring that the
Services are provided in a patient-centered
manner and that the medical needs of all
Child Patients are to the fullest extent
possible met in a primary care context, the
Medical Practitioner’s Normal Contracted
Surgery Hours shall have regard to his/her
Public Patients’ needs in the locality and
he/she shall not amend them without
agreement with the HSE.
The Medical Practitioner shall be routinely
available for consultation at his/her Practice
Premises and for domiciliary visiting for a
total of 40 hours each week on five days or
more in the week by agreement with the HSE
(referred to as Normal Contracted Surgery
Hours).
9.5
The Medical Practitioner shall by way of a
notice outside the Medical Practitioner’s
Practice Premises and by whatever other
appropriate means necessary, such as
practice website (if applicable), make known
his/her Normal/Routine Surgery Hours.
The Medical Practitioner shall make known to
the HSE his/her Normal/Routine Surgery
Hours (including his/her Normal Contracted
Surgery Hours). For the avoidance of doubt,
the Medical Practitioner shall not amend
Normal Contracted Surgery Hours without the
prior agreement of the HSE. Furthermore, the
Medical Practitioner shall provide prior
notification to the HSE of any changes to
his/her Normal/Routine Surgery Hours.
The Medical Practitioner shall make suitable
arrangements to enable contact to be made
with him/her or his/her Locum/Deputy
outside normal hours for urgent cases, and
shall also make such arrangements known by
way of a notice outside his/her Practice
Premises and by whatever other appropriate
means necessary, such as on the practice
website (if applicable).
10 SCOPE OF SERVICES
10.1 On behalf of the HSE, the Medical Practitioner
shall provide for Child Patients all proper and
necessary services to meet patient needs
which are of a kind usually undertaken by a
General Practitioner and/or his/her Staff in a
general practice setting, and not requiring
special skill or experience of a degree or kind
which
General
Practitioners
cannot
reasonably be expected to possess. The
Services required to be provided shall include
health promotion and prevention initiatives as
outlined in Clauses 10.6 and 10.7 hereunder.
It is acknowledged that the Services required
to be provided include certain items for which
specific payments shall be made by the HSE as
set out in Schedule 1 to this Agreement.
10.2 The Medical Practitioner shall take an active
approach toward the assurance of patient
safety and the provision of high quality
services and ensure, as far as possible, that the
services and treatments provided are safe and
comply with the professional standards that
apply to the Medical Practitioner and his/her
staff as determined by the relevant
Professional Regulatory Body.
10.3
The Medical Practitioner shall maintain a
population register of Child Patients registered
on his/her panel. This register will include
relevant demographic and clinical information
relating to the prevention and management of
illness. This register will be in accordance with
the requirements to be set out by the HSE.
10.4
10.5
10.6
10.7
10.8
In the provision of services to Child Patients
under this Agreement, the Medical Practitioner
shall liaise with and/or refer to other health and
social care professionals, where appropriate.
In the interest of patient care and having regard
to patient needs, the Medical Practitioner may
refer to another Medical Practitioner for a
second medical opinion. Payment for such
referrals shall be in accordance with the rate
currently payable under the GMS contract.
The Medical Practitioner shall take an active
approach toward promoting health and
preventing disease through the provision of
Periodic Assessments to Child Patients. On
completion of such assessments, the Medical
Practitioner shall provide a data return to the
HSE in accordance with the agreed dataset as
set out in Appendix 1 to this Agreement.
Assessments will involve the recording of age,
gender, weight and height, and plotting on a
centile chart at ages two and five, and taking
appropriate follow-up action, including where
appropriate, provision of health promotion
advice, brief intervention and support, or
referral to specialist services.
During the
assessments, the Medical Practitioner shall,
where practicable, record whether a child lives
in a smoke free household or not with a view to
providing advice on smoking cessation.
Subject to the provisions of Clauses 10.1 and
10.3 above, the Medical Practitioner shall
maintain a register of Child Patients with a
diagnosis of Asthma and shall provide services
to such patients in accordance with the agreed
Cycle of Care as set out in Appendix 2 to this
Agreement. The Medical Practitioner shall
provide a data return to the HSE in accordance
with the agreed dataset as also set out in
Appendix 2 to this Agreement.
In providing the Services, the Medical
Practitioner shall:
10.8.1 Accept clinical responsibility for Child
Patients on his/her panel who need
medical treatment and treat them or,
when the clinical condition is such that
it is appropriate to transfer them to
appropriate Consultant care, do so and
accept clinical responsibility for them
on becoming aware of their discharge
from Consultant care.
10.8.2 Use the most efficient and economic
forms of treatment or care consistent
with the needs of his/her patients.
10.8.3 Ensure that no discrimination is
exercised between Child Patients and
other patients (including private
patients) and take reasonable steps to
ensure that no such discrimination is
perceived.
10.8.4
Furnish in relation to Child Patients
whom he/she has examined and for
whom he/she is providing Services, a
certificate in relation to any illness
noticed during the examination which
is reasonably required by the Child
Patient’s
Parent(s)/Guardian(s).
Certain other certificates, such as
insurance or assurance policies,
school attendance notes/certificates
are not covered by this contract. The
scope of services under this
Agreement does not include all
services
provided
by
General
Practitioners. The following nonexhaustive list is indicative of some of
the work which is not covered by this
Agreement:
travel
vaccinations,
paediatric phlebotomy, passport /
identity reports / letters, crèche
reports, utilities reports / letters,
insurance medicals / reports, school
attendance notes / certificates, sports
medicals / reports, medico-legal
reports, drug kardexes for state or
private institutions, certificates /
letters in support of applications for
services under the Social Welfare
Acts, certain TUSLA related work such
as
pre-placement
medical
examinations / reports, fostering and
adoption reports. A framework for
such services will be agreed between
TUSLA, the IMO and the HSE.
10.8.5
Ensure that Services are made
available at the Medical Practitioner’s
approved Practice Premises during
Normal/Routine Surgery Hours where
the appropriate facilities, diagnostic
tools and supports are available. The
Medical Practitioner may in the
reasonable exercise of his/her
judgement,
having
given
due
consideration
to
all
relevant
circumstances, provide a domiciliary
consultation where he/she deems it
appropriate for the Child Patient in
accordance with Clause 10.1.
10.8.6
Co-operate with the modernisation of
diagnostic services, including the
introduction of pilot schemes, subject
to agreement with individual Medical
Practitioners, following consultation
with the IMO.
11 PERSONS WHO PERFORM THE SERVICES
11.1 Save where otherwise permitted in
accordance with this Clause 11, the Services
shall be provided personally by the Medical
Practitioner, supported as appropriate by
suitably qualified Staff including the Practice
Nurse.
11.2 The Medical Practitioner may provide the
Services through a suitably qualified
locum/deputy/assistant who is a registered
Medical Practitioner (not being a Medical
Practitioner in respect of whom an
Agreement for the provision of Services
pursuant to the Health (General Practitioner
Service) Act 2014 (or any other publicly
funded health sector contract) is under
suspension or has been terminated in
accordance with Clauses 1 & 5 of Schedule 2)
or through an arrangement set up by the
Medical Practitioner(s) and agreed by the HSE
for the purposes of providing out-of-hours
services (by such registered Medical
Practitioners).
11.3 Where the Medical Practitioner is unable to
provide the Services directly due to long term
sickness or other absence, the Medical
Practitioner must arrange a locum/interim
arrangement to ensure continuity of services
for Patients. Where the absence is likely to
continue for more than six months, the
locum/interim arrangement, which the
Medical Practitioner shall put in place, must
be approved by the HSE. Save in exceptional
circumstances as agreed with the HSE, the
locum’s name must be included in the
Specialist Division of the Register of Medical
Practitioners established under section 43(2)
(b) of the Medical Practitioners Act, 2007, and
the locum should hold a current certificate of
registration within the meaning of Section 2
of that Act in respect of the medical specialty
“General Practice” recognised under Section
89 (1) of that Act. Where the Medical
Practitioner is unable to obtain a locum for a
period of sick leave, the HSE may assume
responsibility
for
organising
a
locum/deputising arrangement directly for a
defined period, following which responsibility
will revert back to the Medical Practitioner.
The appropriate costs for such an
arrangement are the responsibility of the
Medical Practitioner.
The Medical Practitioner shall be entitled to
utilise any contribution towards locum
expenses due to him/her to meet the costs of
such arrangements.
11.4 Save for those circumstances outlined above
where the HSE has appointed a locum/deputy
for a defined duration (Clause 11.3), the
Medical Practitioner shall retain full
responsibility for the proper care of all
patients on his/her panel of Child Patients,
whether provided directly or through a
Deputy, Assistant, short or long term Locum
or other Staff, including the Practice Nurse.
11.5 The Medical Practitioner shall at all times be
in a position to demonstrate that their English
language competency meets the minimum
language requirements as determined by the
Medical Council or HSE following consultation
with the IMO.
11.6 The Medical Practitioner shall for the duration
of the Agreement reside in an area that is
sufficiently proximate to his/her area of
practice such that he/she can discharge all of
the duties and obligations of this Agreement,
including those relating to availability as
specified in Clause 9 herein.
12 PRACTICE PREMISES
12.1 The Medical Practitioner shall ensure that the
Practice Premises and facilities are fit for
purpose, suitable for the delivery of the
services and sufficient to meet the needs of
patients. The Medical Practitioner undertakes
to work towards meeting and maintaining
generally accepted standards in relation to
Practice Premises.
12.2 Without prejudice to the generality of the
foregoing, the Medical Practitioner shall
ensure as a minimum that the Practice
Premises meet the following requirements:
12.2.1
The Practice Premises shall have a
waiting room with a reasonable
standard of comfort and hygiene,
sufficient in size to accommodate the
normal demands of his/her practice
with
adequate
seating
accommodation.
12.2.2
The Practice Premises shall have a
surgery sufficient in size for the
requirements of normal general
practice, with facilities including
adequate lighting, hot and cold
running water, adequate hand
washing facilities, an examination
couch and other essential needs of a
practice, including adequate toilet
facilities for patients.
12.2.3
A high standard of cleanliness shall at
all times be maintained throughout
the Practice Premises.
12.3 The Medical Practitioner shall not change the
location of his/her Practice Premises or open
additional centres of practice (whether under
this Agreement or otherwise) without the
prior approval of the HSE.
13 PRESCRIBING
13.1 The Medical Practitioner shall prescribe such
drugs and medicines, as he/she considers
clinically necessary for any Child Patient for
whom he/she is obliged to provide Services
having regard to patient safety and clinical
effectiveness considerations. The Medical
Practitioner may prescribe appliances from
such categories as may be specified by the
HSE. In prescribing drugs, medicines or
appliances, the Medical Practitioner shall
have due regard to the need for economy but
shall have primary regard for the interest of
the Child Patient.
13.2 The Medical Practitioner shall have regard to
recommendations on the prescribing of drugs,
medicines and appliances which may be
issued from time to time by the Department
of Health/HSE following consultation with the
IMO.
13.3 The Medical Practitioner shall have due
regard to patient safety and public health in
prescribing to Child Patients, including the
control and prevention of antimicrobial
resistance and shall have regard to relevant
clinical guidelines.
13.4 Where a Medical Practitioner suspects that a
Child Patient has suffered an adverse drug
reaction, such a reaction shall be reported to
the Health Products Regulatory Authority and
the report shall be referenced in the Child
Patient’s file. Such reporting shall be carried
out in accordance with the HSE’s required
prescribed procedures, as determined from
time to time.
13.5 The HSE shall make available GMS
prescription forms to the Medical Practitioner
for the purpose of prescribing drugs,
medicines or appliances to Child Patients who
have full eligibility under the Health Act, 1970,
as amended. The Medical Practitioner shall
keep the stocks of these forms carefully and
securely. He/she shall use them only for
issuing prescriptions for Child Patients who
have full eligibility for health services and shall
complete each form in accordance with its
terms.
The Medical Practitioner shall comply with all
legal requirements, including misuse of drugs
legislation, control of sales regulations and
prescription control regulations. The Medical
Practitioner shall write "medically urgent" on
forms where medicine is urgently required.
14 RECORDS
14.1 The Medical Practitioner shall create and
maintain
comprehensive
records
of
attendance on and treatment of Child
Patients and shall ensure that such records:
14.1.1
Demonstrate a full, accurate and
contemporaneous record in respect
of the Services requested and
services provided to Child Patients.
14.2 All Records maintained by the Medical
Practitioner, including electronic records, shall
be dated, legible and shall identify as a
minimum the following information:
14.2.1
Name, address, date of birth, gender,
the card number applying to the
Child Patient pursuant to this
Agreement; treatment code where
applicable,
treatment
dates,
observations,
findings,
advice,
services and treatments provided;
and to record details of all referrals
for each Child Patient;
14.2.2
The
Medical
Practitioner(s)
responsible for carrying out the
Services in respect of each Child
Patient; including where the treating
Medical Practitioner is not the Child
Patient’s registered Doctor of Choice;
14.2.3
The time an out of hours service was
provided and details of clinical
necessity where required to support
an out-of-hours claim in accordance
with Clause 20 or otherwise;
14.2.4
Details of any amendments to the
Records; and
14.2.5
An audit trail of all Records held on
an ICT system (to include full history
of all documents created).
14.3 The Medical Practitioner shall comply with
best practice and with all laws and regulations
governing information security, records’
retention and shall ensure that controls are in
place to preserve the confidentiality, security,
availability and integrity of information
recorded.
14.4 When a Child Patient is transferred to the
panel of another Medical Practitioner (for
whatever reason), the Medical Practitioner
shall, subject to the written consent of the
Parent(s)/Guardian(s) of the Child Patient,
give to the new doctor a summary of the
medical history and condition of the Child
Patient.
14.5 On the death of the Medical Practitioner, the
HSE will arrange through the designated HSE
Officer for the transfer of the Records of the
deceased practitioner to the Medical
Practitioner(s) taking over the provision of
Services to these patients. Where it is
necessary to take custody of the Records this
should be done by the appropriate designated
HSE Officer.
14.6 Where the Medical Practitioner retires or
resigns from this Agreement, the Health
Service Executive should inform the Parent or
Guardian of each Child Patient, when
notifying him/her of the name of the new
Medical Practitioner, that the Records are
being transferred to this Medical Practitioner.
The Parent/Guardian should be notified that if
he/she does not agree to the transfer of
his/her Child Patient’s records, he/she should
indicate this to the HSE within 14 days of the
notification. Records deposited with the
designated HSE Officer may be destroyed
after a reasonable time in accordance with
the HSE’s records retention policy.
15 CO-OPERATION WITH AGREED SURVEYS
15.1 The Medical Practitioner shall co-operate with
agreed surveys which the HSE or the
Department of Health may wish to conduct
from time to time, in pursuance of the
monitoring of the provision of GP Services
free at the point of use to Child Patients,
provided such surveys are agreed with the
Irish Medical Organisation.
16 CO-OPERATION WITH AGREED ICT INITIATIVES
16.1 The Medical Practitioner, where appropriate,
shall co-operate with the introduction of
agreed ICT, eHealth and management
information initiatives as may be introduced
from time to time, including but not limited to
electronic processing of claims, electronic
systems for the ordering and monitoring of
diagnostic services, the roll-out of electronic
messaging,
secure
email,
identity
management services, improved customer
services and panel management functionality.
The introduction of such initiatives shall be
agreed with the IMO under the provisions of
the Framework Agreement.
16.2 Nothing in the Clause 16 or elsewhere in this
Agreement shall require the Medical
Practitioner to put in place an ICT or new
computer system within their practice.
17 FEES
17.1 The HSE shall, in consideration of the Services
provided by the Medical Practitioner, and on
foot of claims made in the forms and at the
times provided for herein, pay or arrange
payment of the Fees to the Medical
Practitioner. The Fees are as set out in
Schedule 1 but may be amended by the
Minister from time to time following
consultation with the Relevant Representative
Bodies.
17.2 The Medical Practitioner shall not demand or
accept any payment or consideration
whatsoever other than the Fees determined in
accordance with this Clause 17 in reward for
the Services provided by him/her or by others
on his/her behalf under this Agreement, or in
respect of any expenses incurred by him/her
in making the Services available. The Medical
Practitioner shall instruct any Deputy,
Assistants or members of Staff providing
Services on his/her behalf to comply with the
provisions of this Clause 17. This Clause 17
shall not apply to services which are not
comprehended by this Agreement but which
the Medical Practitioner may provide from
time to time.
17.3 Any breach of Clause 17.2 by the Medical
Practitioner or his/her Staff or by anyone
acting on behalf of the Medical Practitioner
(whether with or without the knowledge of
the Medical Practitioner) shall be treated as a
serious breach of the Agreement and may be
subject to the sanctions set out in Schedule 2.
17.4 The allowances and subsidies available under
the GP Contracts are, to the extent applicable,
also available under this Agreement and are
detailed in Schedule 1.
17.5 Where the Medical Practitioner also holds a
GMS Contract and/or a GP Visit Card Contract,
the number of persons on the Medical
Practitioner’s panel of Child Patients (under
this Agreement) will be aggregated with the
number of patients on his/her GMS Contract
and GP Visit Card Contract for the purpose of
calculating the amount of any subsidies or
allowances to be paid to the Medical
Practitioner.
17.6 The Medical Practitioner shall maintain such
supporting documentation as the HSE requires
to demonstrate that any and all Fees claimed
by the Medical Practitioner are reasonable and
accurate in both kind and amount. In this
regard, the Medical Practitioner shall record
both the details and amounts of any Fees
received by the Medical Practitioner and the
dates upon which payment of such Fees was
made.
17.7
The HSE may from time to time carry out
such examinations as it considers necessary
to verify the accuracy and reasonableness of
claims submitted and the Medical
Practitioner agrees to co-operate with such
examinations and to provide the HSE with
copies of such supporting documentation as
it requires.
17.8
Payments of Fees shall be made monthly in
arrears and allowances shall be paid at least
quarterly. Where an amount of claim is in
dispute, full payment as specified in
Schedule 1 shall be made on account
pending the outcome of the Dispute
Resolution Procedure, where invoked,
except in the case of clear mistake,
inaccurate or incomplete details submitted
in support of claim or misrepresentation on
the part of the claimant. Payments on
account shall not be made where the
disputed claim(s) is comprehended by sub
clause 2.1.4 and/or 2.1.5 of Schedule 3 to
this Agreement.
17.9
Where the outcome of the Disputes
Resolution process is that the disputed
claims are payable then the claiming Medical
Practitioner shall be entitled to submit such
claims and receive payments from the HSE
for same in accordance with the payment
rates set out in Schedule 1 to this
Agreement. Where the outcome is that the
payment(s) in dispute was not payable,
payments on account will cease with
immediate effect and the value of all
payments on account paid in respect of such
claims shall be recouped from the claiming
Medical Practitioner by the HSE.
17.10 Where the Medical Practitioner does not
engage with the Dispute Resolution
procedure and/or fails to reply to
correspondence on the matter in dispute
within a period of four weeks from the date
of the issue in dispute first arising or four
weeks from the receipt of correspondence,
whichever may be the later, the HSE may,
without prejudice to its other rights under
this Agreement, set off the relevant amount
against other amounts payable by the HSE to
the Medical Practitioner.
17.11 Payment of Fees shall be subject to the
Medical Practitioner holding and maintaining
an up-to-date Tax Clearance Certificate.
17.12 Professional Services Withholding Tax shall
be deducted at the standard rate from any
payments made by the HSE unless proof of
exemption is provided by the Medical
Practitioner.
17.13 Payment of Fees by the HSE shall be without
prejudice to any claims or rights which the
HSE may have against the Medical
Practitioner and shall not constitute any
admission by the HSE as to performance by
the Medical Practitioner of his/her obligations
hereunder.
18 AGREEMENT SUSPENSION,
TERMINATION PROCEDURE
SANCTION
AND
18.1 Without prejudice to all other rights of the
HSE under the Agreement, in the event of a
breach by the Medical Practitioner of any
term or provision of the Agreement, the HSE
may have recourse pursuant to Schedule 2 to
this Agreement (Agreement Suspension,
Sanction and Termination Procedure).
18.2 For the avoidance of doubt, the HSE shall, in
its discretion, be entitled to exercise its rights
pursuant to Schedule 2 to this Agreement,
notwithstanding the fact that the Dispute
Resolution Procedure has been initiated in
accordance with Schedule 3.
19 APPOINTMENT OF MEDICAL PRACTITIONER
19.1 In consideration of being appointed and being
paid the Fees, the Medical Practitioner shall
provide the Services in accordance with the
terms and conditions of the Agreement.
19.2 Without prejudice to the generality of the
foregoing, the Medical Practitioner shall, and
shall procure that his/her Staff shall, in the
provision of the Services, exercise due
diligence and comply fully with appropriate
professional
standards,
all
applicable
legislation (and all regulations and orders
made under such legislation).
19.3 The Medical Practitioner undertakes in the
provision of the Services to protect and
promote the safety and well-being of children
and shall ensure full compliance with any such
legal obligations in this regard. He/she shall
co-operate with the relevant statutory bodies
in relation to child protection matters.
20 OUT-OF-HOURS PAYMENTS
20.1 Out-of-hours claims may only be made in
respect
of
appropriate
out-of-hours
treatment given by the Medical Practitioner
outside of the hours 9am to 5pm Monday to
Friday and during all hours on Saturdays,
Sundays, Public Holidays and Good Friday,
subject to the terms and conditions of this
Clause 20.
20.2 For the purpose of an out-of-hours claim, the
HSE will require appropriate third party
verification of the time of the consultation.
20.3 Out-of-hours claims may not be made in
respect of consultations held during Normal
Contracted Surgery Hours or Normal/Routine
Surgery Hours. Out-of-hours payments will
only be made in circumstances where the
patient consultation is unforeseen, nonroutine and necessarily carried out out-ofhours, and cannot be safely deferred until
Normal Contracted Surgery Hours or
Normal/Routine Surgery Hours.
20.4 Notwithstanding the fact that a Medical
Practitioner may have suitable alternative
out-of-hours arrangements, an urgent and
unforeseen consultation may be the subject
of an out-of-hours claim if the service
provided by that out-of-hours service is not
readily available and/or the Child Patient’s
complaint is such that he/she required
immediate attention and in the opinion of the
treating Medical Practitioner it would be
injurious to his/her health to wait to attend
the Co-op out-of-hours service.
20.5 Out-of-hours claims will not be paid in any or
all of the following circumstances:20.5.1
The consultation is not urgent and/or
unforeseen.
20.5.2
The consultation takes place during
an overflow clinic.
20.5.3
The consultation takes place during
Normal Contracted Surgery Hours.
20.5.4
The consultation takes place during
Normal/Routine Surgery Hours.
20.5.5
The patient did not require urgent
treatment directly by the Medical
Practitioner concerned.
20.5.6
No face to face out-of-hours
consultation actually took place.
20.5.7
The consultation
routine.
20.5.8
The time of the consultation was not
during the specified out-of-hours
period.
is
otherwise
20.6 The decision by a Medical Practitioner to
accept or refuse a consultation in respect of
any of the foregoing circumstances shall be
taken by that Medical Practitioner having
regard, inter alia, to the provisions of this
Agreement and his/her obligations under
Medical Council guidelines.
20.7 The Medical Practitioner shall not be entitled
to make an out-of-hours claim in respect of
consultations that are offered to a patient
outside normal hours, merely to facilitate the
preference of the Child Patient or his/her
Parent(s)/Guardian(s).
20.8 It is the obligation of the Medical Practitioner
to ensure that all appropriate claim forms are
completed accurately and fully. Out-of-hours
claims may only be made by the Medical
Practitioner on whose panel the Child Patient
is registered, or by a partner of that
practitioner who is also a Medical Practitioner
and who has entered into a recognised rota
arrangement with the Child Patient’s doctor,
where such arrangements have been
approved by the HSE. Such arrangements may
include out-of-hours co-operative rotas.
21 VARIATION
21.1 The HSE may, following consultation under
the Framework Agreement with the Irish
Medical Organisation, vary the Agreement
(other than the Fees determined in
accordance with Clause 17.1) where:
21.1.1
The HSE is reasonably satisfied that it
is necessary to vary the Agreement
so as to meet its obligations under
the Act or other legislation or
regulations, or any direction given by
the Minister; and
21.1.2
The HSE notifies the Medical
Practitioner in writing of the wording
of the proposed variation and the
date upon which that variation is to
take effect.
21.1.3
Where reasonably practicable, the
date that the proposed variation
shall take effect shall be not less than
30 days after the date on which
notice in accordance with Clause 25
is served on the Medical Practitioner.
21.2 If the Medical Practitioner wishes to
terminate the Agreement following notice of
any amendment, the Medical Practitioner
shall be entitled to do so in accordance with
Clause 4.1 of Schedule 2 and shall be
permitted to serve out the required three
months’ notice on the pre-existing terms and
conditions of the Agreement (save in
exceptional circumstances where immediate
implementation of the variation is essential in
order to protect health and safety).
22 AUTHORISED AGENT
22.1 Neither party to this Agreement shall be the
authorised agent of the other party or have
the right or authority, either express or
implied, to create or incur any liability against
or on behalf of any other party, other than
those obligations and liabilities set out
hereunder. In particular, the Medical
Practitioner shall not hold himself/herself out,
nor permit any person to hold him/her out, as
being authorised to bind or pledge the credit
of the HSE in any way and shall not do any act
that might reasonably create the impression
that he/she is so authorised.
25.3
25.2.1 Any serious incident that in the
reasonable opinion of the Medical
Practitioner prevents or is likely to
prevent the Medical Practitioner’s
performance of his/her obligations
under the Agreement.
The Medical Practitioner shall immediately
notify and obtain the prior approval of the
HSE of any changes or proposed changes in
the details supplied by him/her and included
in this Agreement. The Medical Practitioner
shall not unreasonably request any such
changes and the HSE shall not unreasonably
withhold its consent to such requests.
23 DATA PROTECTION
23.1 The Medical Practitioner and the HSE shall
comply with their respective obligations
under the Data Protection Act 1988 and 2003
as may be amended and all regulations made
thereunder (referred to as “Applicable Data
Protection Legislation” for the purposes of
this Clause 23), in the collection and storage
of data pursuant to the Agreement.
25.4
Without prejudice to the generality of the
foregoing, the Medical Practitioner’s Normal
Contracted Surgery Hours shall have regard
to patient needs in the community and the
Medical Practitioner shall, prior to
implementing any such change, first obtain
the HSE’s approval and shall at all times cooperate with the HSE in order to ensure that
patient needs continue to be met.
24 FREEDOM OF INFORMATION
24.1 The Medical Practitioner acknowledges that
the HSE is subject to the provisions of the
Freedom of Information Act 2014 (as may be
amended) and that the HSE may be obliged to
disclose information regardless of any
representations made by the Medical
Practitioner. However, where a request is
made for information furnished by, or which
concerns, the Medical Practitioner, the HSE
shall, where appropriate, endeavour to
consult the Medical Practitioner before
responding to such a request.
25.5
Failure by the Medical Practitioner to obtain
the
HSE’s
prior
approval
before
implementing changes specified in this
Agreement may cause the HSE to invoke the
Disciplinary Provisions of this Agreement in
accordance with the procedures set out in
Schedule 2.
25.6
The notifications and approvals effected in
accordance with this Clause 25 shall form
part of the Agreement.
25 NOTIFICATIONS
25.1 Any
notice,
notification
or
other
communication given or made under this
Agreement shall be in writing and signed by or
on behalf of the party giving it and shall be
served by delivering it personally, or sending
it by pre-paid recorded delivery or registered
post to the relevant party. In the case of
communications
to
the
HSE,
such
communications shall be addressed to the
Authorised Representative of the HSE. In the
case of the Medical Practitioner, all
communications shall be made to the Medical
Practitioner’s last known address, or by
sending it by fax or email to the fax number or
email address notified by the relevant party to
the other party.
25.2 In addition to any requirements of notification
set out above or elsewhere in this Agreement
or the Schedules, the Medical Practitioner
shall notify the HSE in writing, as soon as is
reasonably practicable, of:
26
WARRANTIES AND INDEMNITIES
26.1 The Medical Practitioner warrants that:
26.1.1 All information in writing provided to
the HSE in seeking to become a party
to this Agreement was, when given,
true and accurate in all material
respects;
26.1.2 No information has been omitted
which would make the information
that was provided by the Medical
Practitioner to the HSE materially
misleading or inaccurate;
26.1.3 No circumstances have arisen which
materially affect the truth and
accuracy of such information;
26.1.4 He/she is not at the date of this
Agreement aware of anything within
his/her reasonable control which
may or will materially adversely
affect his/her ability to fulfil his/her
obligations under this Agreement.
26.2
The Medical Practitioner further warrants
and undertakes to the HSE and it shall be a
condition of this Agreement that:
26.2.1
The Medical Practitioner and Staff have
the
appropriate
qualifications,
competence and authority to carry out
the Services and are compliant with
professional registration requirements as
appropriate;
26.2.2
The Services shall at all times be provided
in a manner consistent with the
provisions of this Agreement;
26.2.3
The Services shall comply with all
necessary safety precautions and safety
legislation relevant to the provision of
the Services including but without
limitation the Safety, Health and Welfare
at Work Act, 2005 and any amendments
thereof and/or regulations rules or
orders made pursuant thereto, including
the Safety Health and Welfare at Work
(General Applications) Regulations 1993,
2001, 2003 and 2012, the Confined Space
Regulations 2001 and any amendments
thereof.
27 INSURANCE
27.1 The HSE is relying upon the judgment and
expertise of the Medical Practitioner and
his/her Staff in providing the Services and
accordingly, the Medical Practitioner shall
maintain in force at all times insurance
policies or indemnity arrangements (including
membership of a medical defence
or
protection organisation where there is
provision for medical indemnity insurance or
other indemnity arrangement for clinical
negligence claims against the member) in
respect of all customary liabilities and risks
undertaken by the Medical Practitioner in
connection with the provision of the Services
or as may reasonably be required by the HSE
or by law (including professional indemnity
insurance or other indemnity arrangement,
employer's liability insurance and public
liability insurance). The arrangements must be
adequate to cover the Medical Practitioner’s
liabilities under the Agreement and
commensurate with the full time nature of
this Agreement.
27.2 The Medical Practitioner undertakes to
ensure that his/her employees, agents or
representatives employed for the purpose of
providing the Services are covered by
equivalent
professional
indemnity
insurance/cover. For the avoidance of doubt,
this does not impose an obligation on the
Medical Practitioner to procure directly or
fund the cost of professional indemnity
insurance/cover for his/her employees,
agents or representatives employed for the
purpose of providing the Services.
27.3 The Medical Practitioner shall not knowingly
do or permit or suffer to be done any act or
thing whereby the insurances or indemnity
arrangements (as set out in sub clause 27.1)
required by this Clause 27 may lapse or
become in whole or in part void or voidable.
27.4 The Medical Practitioner shall comply with all
terms and conditions of his/her insurance
policies or indemnity arrangements (as set
out in sub clause 27.1) at all times. If cover
under the said policies/arrangements shall
lapse or not be renewed or changed in any
material way the Medical Practitioner shall
notify the HSE without delay.
28 INSPECTIONS
28.1 The HSE shall be entitled to carry out
inspections of the Premises and the Records
used by the Medical Practitioner for the
purposes of the Agreement where the HSE
has concerns in relation to the manner in
which the Medical Practitioner is discharging
his/her obligations under this Agreement,
such inspections shall ordinarily be by prior
arrangement with the Medical Practitioner.
28.2 The Medical Practitioner shall facilitate at all
reasonable times such inspection of the
Premises and the Records used by the
Medical Practitioner for the purposes of the
Agreement as may be required by the HSE
which shall include allowing the HSE access to
any information which is reasonably required
by the HSE for the purposes of or in
connection with the Agreement and/or the
HSE’s statutory functions. Inspection shall
ordinarily be by prior arrangement with the
Medical Practitioner.
28.3 The HSE’s right to inspect pursuant to this
Clause 28 shall be subject to the jurisdiction
of any other relevant statutory body to carry
out inspections. The HSE reserves the right to
notify the Medical Council of any matters
which may be of relevance to the Medical
Council and of which the HSE becomes aware
during the course of an inspection. The HSE
shall inform the Medical Practitioner of any
such notification as appropriate.
28.4 The Medical Practitioner shall co-operate with
inspections conducted pursuant to this Clause
28, including facilitating interviews between
the Medical Practitioner, the Staff (where
appropriate) and the HSE or any Authorised
Representatives of the HSE.
28.5 The HSE shall, subject to Data Protection
Legislation, including where applicable under
said legislation the requirement to obtain
patient consent, be entitled to make copies
(including electronic copies) of any Records
during the course of an inspection and the
Medical Practitioner shall facilitate the taking
of such copies.
28.6 Once the Medical Practitioner is notified of an
inspection of his/her practice pursuant to this
Clause 28, the Medical Practitioner shall not
remove any information or document relating
to his/her performance under or compliance
with this Agreement from the Practice
Premises without the prior consent of the HSE
unless its removal is required in the interests
of a patient, in which case the Medical
Practitioner shall keep a written record of
what was removed, the reasons for its
removal and shall provide to the HSE such
record in the conduct of any inspection.
28.7 In the event that an inspection conducted
under this Clause 28 reveals that the Medical
Practitioner is failing to provide the Services,
or part thereof, in accordance with the terms
and conditions of this Agreement, the HSE
shall be entitled to exercise any relevant
rights or remedies available to it under this
Agreement, including the right to invoke the
disciplinary process pursuant to Schedule 2.
28.8 If the Medical Practitioner considers it
necessary, he/she shall be entitled to the
benefit of legal representation during the
course of any inspections undertaken
pursuant to this Clause 28. The cost of any
such representation shall be borne by the
Medical Practitioner.
29 INTELLECTUAL PROPERTY RIGHTS
29.1 The Medical Practitioner shall not be entitled,
without the HSE’s permission, to use the
HSE’s name or logo on any material,
advertising, marketing, promotion or product
owned or controlled by the Medical
Practitioner.
30 ASSIGNMENT, TRANSFER AND SUB-CONTRACTING
30.1 The Medical Practitioner shall not be entitled
to sub-contract, assign or transfer the
Agreement or any part thereof or the benefit
or advantage of the Agreement or any part
thereof.
30.2 The Agreement shall be binding upon
successors and assigns of the HSE and the
name of the HSE appearing in the Agreement
shall be deemed to include the names of its
successors and assigns.
31 COSTS
31.1 Each party to this Agreement will pay its own
costs of and incidental to the consultation and
execution of this Agreement.
32 REMEDIES CUMULATIVE
32.1 The provisions of this Agreement, and the
rights and remedies of the parties under this
Agreement, are cumulative and are without
prejudice and in addition to any rights or
remedies a party may have at law or in equity.
No exercise by a party of any one right or
remedy under this Agreement, or at law or in
equity, will (save to the extent, if any,
provided expressly in this Agreement, or at
law or in equity) operate so as to hinder or
prevent the exercise by it of any other such
right or remedy.
33 FORCE MAJEURE
33.1 For the purposes of this Clause 33, the
expression “Force Majeure” shall mean fire,
flood, pandemic or any disaster affecting or
delaying the performance by a party of its
obligations. Any act, event, omission,
happening or non-happening shall only be
considered Force Majeure if it is not
attributable to the wilful act, neglect or failure
to take reasonable precautions of either party
to the Agreement seeking to rely on it, or of
that party’s agents or employees.
33.2 Neither party to the Agreement shall in any
circumstances be liable to the other for any
loss of any kind whatsoever directly or
indirectly caused or incurred by the other
party by reason of any failure or delay in the
performance of its obligations hereunder
which is
due to Force Majeure.
Notwithstanding the foregoing, each party
shall use all reasonable endeavours to
continue to perform, or resume performance
of, such obligations hereunder for the
duration of such Force Majeure event.
33.3 If either the HSE or the Medical Practitioner
becomes aware of circumstances of Force
Majeure which give rise to or which are likely
to give rise to any such failure or delay on its
part it shall forthwith notify the other by the
most expeditious method then available and
shall inform the other of the period which it is
estimated that such failure or delay shall
continue.
33.4 Where the Force Majeure event is continuing
for a period of at least one month, the other
party shall have the right to terminate this
Agreement upon seven days notice.
33.5 It is expressly agreed that any failure by the
Medical Practitioner to perform, or any delay
by the Medical Practitioner in performing
his/her obligations under this Agreement,
which results from any failure or delay in the
performance of his / her obligations by any
person, firm or company with which the
Medical Practitioner has a contract, supply
arrangement or otherwise shall be regarded
as a failure or delay due to Force Majeure
only in the event that such person, firm or
company shall itself be prevented from or
delayed in complying with its obligations
under such contract, supply arrangement or
otherwise as a result of circumstances of
Force Majeure.
35.1.1
Clause 23 (Data Protection);
35.1.2
Clause 24 (Freedom of Information);
35.1.3
Clause 28 (Inspections);
35.1.4
Clause 29 (Intellectual Property
Rights);
35.1.7
Schedule 1 (Fees and Allowances
payable under Agreement);
35.1.8
Schedule 2 (Agreement Suspension,
Sanction and Termination);
35.1.9
Schedule 3 (Dispute Resolution);
37.1 Each party to this Agreement shall from time
to time execute such further assurances and
do such things and afford to the other party
such assistance as may reasonably be
required for the purpose of giving full effect
to the terms of this Agreement.
38 FORBEARANCE AND WAIVER GENERALLY
38.1 The rights of either party to this Agreement
will not be prejudiced or restricted by any
indulgence or forbearance extended to the
other party, and no waiver by a party in
respect of any breach will operate as a waiver
in respect of any subsequent breach. No
failure or delay by a party in exercising any
right or remedy will operate as a waiver
thereof, nor will any single or partial exercise
or waiver of any right or remedy prejudice its
further exercise or the exercise of any other
right or remedy.
34.4 Nothing in this Clause 34 shall have the effect
of limiting or restricting any liability of a party
arising as a result of fraud.
35.1 Unless expressly provided, no term of this
Agreement shall survive expiry or termination
of this Agreement. Express provision is made
in relation to:
Clause 40 (Disputes and Jurisdiction);
37 FURTHER ASSURANCES
34.3 The Medical Practitioner acknowledges that
he/she has not been induced to enter into the
Agreement by a statement or promise which
the Agreement does not contain. The HSE is
not liable in equity, agreement or tort or in
any other way for a representation that is not
set out in the Agreement.
35 NON SURVIVAL OF TERMS
35.1.6
36.1 All the terms and provisions of this
Agreement are distinct and severable, and if
any term or provision is held unenforceable,
illegal or void in whole or in part by any court,
regulatory authority or other competent
authority it shall to that extent be deemed
not to form part of this Agreement, and the
enforceability, legality and validity of the
remainder of this Agreement shall not be
affected.
34.1 The Agreement contains the entire
agreement between the parties and contains
all the terms which the parties have agreed
with respect to its subject matter.
34.2 Neither party has relied on any other written
or
oral
agreement,
representation,
arrangement or understanding.
Clause 39 (Governing Law);
36 SEVERABILITY
33.6 For the avoidance of doubt, it is hereby
expressly declared that the only events which
shall afford relief from liability for failure or
delay shall be events falling within the
definition of Force Majeure set out in this
Clause 33.
34 ENTIRE AGREEMENT
35.1.5
39 GOVERNING LAW
39.1 The Agreement and all relationships created
hereby will in all respects be governed by and
construed in accordance with the laws of
Ireland.
40
DISPUTES AND JURISDICTION
40.1 The parties agree to endeavour to resolve any
disputes as to the operation of this
Agreement in accordance with the provisions
set out in Schedule 3 hereto.
40.2 Without prejudice to the foregoing, each
party hereby irrevocably submits to the nonexclusive jurisdiction of the Irish courts in
relation to any disputes which may arise out
of or in connection with this Agreement or its
performance or enforcement.
41 REVIEW OF INTERIM CONTRACT
41.1 This contract is intended to be an interim
contract which will be replaced by an overall
GP Contract to be agreed between the
Department of Health/HSE and IMO as set out
in the Memorandum of Understanding and in
accordance with the Framework Agreement.
41.2 In the event that a new GP contract is not
agreed by the 31st of July 2016 a review of
this contract will commence no later than the
1st of August 2016 unless otherwise agreed
between the parties. Any such review will be
carried out in accordance with the
aforementioned Framework Agreement.
SCHEDULE 1. FEES AND ALLOWANCES PAYABLE TO MEDICAL PRACTITIONERS UNDER AGREEMENT
FOR THE PROVISION OF SERVICES FOR THE HEALTH (GENERAL PRACTITIONER
SERVICE) ACT 2014 (UNDER 6 YEAR OLDS)
Fees and Allowances payable to GP contract holders in respect of Child
Patients on their panel
Annual Capitation Fee per Child Patient on the GP’s panel, which
includes two periodic assessments, one at age two and one at age five.
Initial Asthma diagnosis and registration after the Child Patient
reaches the age of two years
Enhanced capitation in year one post registration (subject to
submission of annual dataset return). Includes two visits, one at three
months post registration and an annual review visit.
Enhanced capitation for each subsequent year up to and including the
age of five years (subject to submission of annual dataset return)
€125.00
€50.00
€90.00
€45.00
Special Services (Special Items of Service) for Under 6 Patients
Service
Amount
Removal of lodged or impacted foreign bodies from the:
(a) ear
(b) nose
(c) throat
(d) skin
€24.80
Removal of adherent foreign bodies from the conjunctival surface of
the eye
€24.80
Suturing of cuts and lacerations (including application of tissue glue)
€37.21
Excisions/cryotherapy/diathermy of skin lesions
€24.80
Draining of abscess
€24.80
Nebuliser treatment in the case of acute asthmatic attack
€37.21
Treatment and plugging of nasal and dental haemorrhages
€24.80
Attendance by General Practitioner at case conferences
€62.02
All Other relevant payments, such as Out-of-Hours, Rural Practice Allowance,
Second Medical Opinion, Practice Support Subsidies, Contribution towards Locum
expenses, etc. will be in accordance with the rates payable under the General
Medical Services (GMS) Capitation Contract.
SCHEDULE 2. AGREEMENT SUSPENSION, SANCTION AND TERMINATION PROCEDURE
1
DISCIPLINARY PROVISIONS
1.1
The rules of natural justice and fair procedure shall apply to this Agreement. It is a fundamental and
underlying principle of the disciplinary procedure set out hereunder that any Medical Practitioner who is
the subject of a complaint/investigation will have the full right to be heard and to set out his/her own
defence. A Medical Practitioner shall be entitled to be legally represented or to be represented by
his/her representative body. For the avoidance of doubt this does not impose an obligation on the HSE
to either procure or directly fund legal representation on behalf of any medical practitioner.
1.2
Where the National Director, Primary Care Division has reason to believe that the Medical Practitioner
has failed to comply with any of the terms of the agreement, he/she shall notify the Medical Practitioner
in writing of the reasons for such belief by registered post and inform him/her that he/she shall consider
any representations in regard to the matter which may be received by him/her from the Medical
Practitioner, or on his/her behalf, within one month of the issue of the notification, or such longer
period as determined by the National Director, Primary Care Division on foot of a request from or on
behalf of the Medical Practitioner.
1.3
The National Director Primary Care Division shall not consider a complaint relating to an individual living
patient except where:
1.4
1.3.1
It is made by the patient, by a member of his/her family, or by another person with the written
consent of the patient, or where the patient is a child, his/her Parent or Guardian and is in
writing and signed by the person making it and;
1.3.2
It is made within six weeks of the event or alleged event, or within such longer period as the
National Director Primary Care Division may determine following consultation with a member
of the HSE’s Primary Care Division Management Team and a HSE registered Medical
Practitioner, who may or may not be a member of the HSE’s Primary Care Division
Management Team.
The National Director Primary Care Division may, if he is satisfied, after consideration of any
representations which the Medical Practitioner may make or have made on his/her behalf in regard to
the matter and following the conduct of an investigation in to the matter, form the view that:
1.4.1
There is no basis for proceeding with the complaint.
Or
1.4.2
The Medical Practitioner has not complied with the terms of the agreement and if he/she so
thinks fit, either –
(a)
Issue a verbal or written warning to the Medical Practitioner or otherwise communicate
appropriately with him/her; or
(b) Request the Director General to establish a committee pursuant to Clause 1.6 of this
Schedule 2 for the purpose of examining a complaint (Clause 1.3 of this Schedule 2) or
alleged failure to comply with the terms of this agreement (Clause 1.2 of this Schedule 2).
1.5
A Medical Practitioner in respect of whom the National Director Primary Care Division has issued a
verbal or written warning pursuant to sub-clause 1.4.2 (a) of this Schedule 2 may appeal the decision of
the National Director, Primary Care Division to the Director General to review the matter and issue a
final determination. In reviewing an appeal under this sub-clause the Director General shall consult with
two members of the HSE Management Team one of whom shall be a Registered Medical Practitioner.
1.6
The committee established by the Director General to examine a complaint or alleged failure to comply
with the terms of this agreement (under Clause 1.4.2 (b) above) shall consist of:
1.7
1.8
1.6.1
One person who shall be legally qualified (being chairman of the Committee) who shall be
nominated by the Minister; and
1.6.2
Two persons selected by the Director General in person; and
1.6.3
Two persons nominated by the relevant representative body or by the Medical Practitioner.
A committee established in accordance with Clause 1.6 of this Schedule 2, shall act in accordance with
the following rules:1.7.1
Subject to the provisions of sub clause 1.7.2 of this Schedule 2, the committee may act
notwithstanding any vacancy among its members.
1.7.2
The committee may not act unless the Chairman and at least one of the persons selected by the
Director General in person and one of the persons nominated by the relevant representative
body (or by the Medical Practitioner) are present.
1.7.3
The chairman of the committee shall convene the first meeting of the committee not less than
ten days after the committee is established.
During the conduct of the committee's proceedings, the chairman shall have discretion as to the
conduct of the proceedings and in particular shall:
1.8.1
Decide the order of appearance of persons appearing before the committee;
1.8.2
Permit the Medical Practitioner concerned, or the National Director Primary Care Division, to
appear in person or to be represented and/or assisted by another person, which may include
legal representation or representation by the Medical Practitioner’s representative body; and
1.8.3
Hear any relevant person(s) who is/are not a party to the proceedings.
1.8.4
Grant the Medical Practitioner the right to be represented and have prior sight of all allegations
and any evidence against the Medical Practitioner and the right to adduce evidence and call
witnesses on the Medical Practitioner’s own behalf.
1.9
Any questions arising before the committee shall be decided by the majority of the members of the
committee who are present and vote and, in case of an equality of votes on any question, the chairman
shall have a second or casting vote.
1.10
The committee shall make its recommendations in writing to the National Director Primary Care Division
who shall notify in writing (within seven days) the Medical Practitioner concerned of the
recommendations.
1.11
A committee shall complete its examination of a complaint with all practicable speed. It shall ordinarily
conclude its deliberations and issue its recommendations within 6 months of the date of its inaugural
meeting unless, in the opinion of the Chairman, exceptional circumstances exist that warrant extending
the period of examination. This could include, but is not limited to, the medical practitioner being
unavoidably indisposed due to illness. A decision to extend the period of examination is made by the
Chairman following consultation with at least one member of the committee nominated by the Director
General and one member of the committee nominated by the relevant representative body (or by the
Medical Practitioner).
1.12
Where a committee upholds a complaint, it may:
1.12.1
Recommend to the HSE that the Medical Practitioner should be admonished;
1.12.2
Recommend to the HSE that the Medical Practitioner should undergo specific periods of
educational training and/or supervised practice, the cost of which will be borne by the Medical
Practitioner;
2
1.12.4
Recommend termination of the agreement between the HSE and the Medical Practitioner;
Where the committee recommends the termination of the agreement, the National Director Primary
Care Division shall notify in writing (within seven days of receipt of the committee's recommendation)
the Medical Practitioner concerned that the agreement shall be terminated on behalf of the HSE after
the expiration of a period of 21 days, unless a request has been made to the Director General under
Clause 1.14 of this Schedule 2. The National Director Primary Care Division may where appropriate
notify in writing the Registrar of the Irish Medical Council of the recommendation of the Committee and
shall on request from the Registrar supply such particulars as may be necessary for the Council to
consider the matter.
1.14
The Medical Practitioner in relation to whom a recommendation has been made under Clause 1.12 of
this Schedule may request the Director General to issue a direction to the National Director Primary
Care Division in person in relation to that recommendation as detailed in Clauses 1.15 and 1.16 of this
Schedule 2.
1.15
A request under Clause 1.14 of this Schedule 2 shall be submitted in writing to the Director General
either by the Medical Practitioner concerned or on his/her behalf and shall specify the grounds on which
the Medical Practitioner requests the Director General to issue a direction in person to the National
Director Primary Care Division and the Director General shall notify the National Director Primary Care
Division in person of the receipt of such request.
1.16
Where a request is made to the Director General under Clause 1.15 of this Schedule 2, the Director
General may consult with two members of the HSE’s Management Team, (not being the National
Director Primary Care Division) and one of whom being a registered medical practitioner (not being the
medical practitioner referenced in Clause 1.3.2 or Clause 2.1 of this Schedule 2. The Director General in
person may give to the National Director Primary Care Division a direction (being a direction to comply
with the recommendation of the committee) or such other direction (being a direction to reduce the
severity of sanction or overturn the recommendation of the Committee) as the Director General
considers appropriate and the National Director Primary Care Division shall comply with any such
direction.
SUSPENSION OF AGREEMENT
Where the National Director Primary Care Division, following consultation with two members of the
HSE’s Management Team, other than the Director General and one of whom being a registered medical
practitioner, is satisfied that the care of patient(s) is placed in jeopardy, he may in accordance with this
Clause, suspend the operation of a Medical Practitioner’s agreement pending investigation of a
complaint under the preceding paragraphs. In such circumstances, the Committee referred to in Clause
1.6 to this Schedule 2 shall in all cases meet to consider the matter on a date not later than three weeks
from the date of the suspension.
AUTOMATIC TERMINATION
3.1
4
Recommend to the HSE that a deduction of a specified sum of money should be made from
monies due to the Medical Practitioner under this agreement in accordance with its terms;
1.13
2.1
3
1.12.3
For the avoidance of doubt, the Agreement shall terminate automatically on the Medical Practitioner
reaching the age of 72 years. The Medical Practitioner, if required by the HSE, shall, on entering into the
Agreement, furnish evidence of his/her date of birth.
TERMINATION BY MEDICAL PRACTITIONER ON NOTICE
4.1
The Medical Practitioner may terminate this Agreement on giving three months’ notice in writing of
his/her intention to terminate or such shorter period as may be accepted by the Health Service
Executive.
5
TERMINATION BY HSE FOR DEFAULT
5.1
The National Director Primary Care Division shall be entitled to terminate this Agreement without
consequential liability to the Medical Practitioner with immediate effect if he/she is satisfied that it is
appropriate to do so if:5.1.1
It has been established on foot of a determination by a competent medical examiner
nominated by the HSE, following consultation with the Medical Practitioner’s Representative
Body, that the Medical Practitioner is suffering from permanent infirmity of mind or body that
impedes the Medical Practitioner’s ability to carry out the services. Where a dispute exists as
to the findings of the medical examiner or where a conflicting medical opinion is provided to
the HSE by a competent medical examiner on behalf of the Medical Practitioner, the HSE shall
refer the person in respect of whom there are concerns to an independent medical examiner
and shall take the findings of this medical examiner into consideration in arriving at its final
conclusion.
5.1.2
The Medical Practitioner is removed from the register of General Practitioners maintained by
the Medical Council or from the register of an equivalent authority in any jurisdiction;
5.1.3
The Medical Practitioner; has been found guilty by a court of law of committing any fraudulent
act or any indictable offence or gross negligence;
5.1.4
The Medical Practitioner takes up full-time employment with the HSE or within the wider public
sector; and the HSE, following a review of the circumstances, decides in its discretion that a
conflict of interest situation exists.
5.2
A Medical Practitioner in respect of whom a decision has been made by the National Director Primary
Care Division in accordance with Clause 5.1 of this Schedule 2 shall be entitled to request a referral of
this decision to a committee appointed by the Director General. The composition of the committee
shall be as outlined in Clause 1.6 of this Schedule 2. Where applicable, the rules governing the
committee are as outlined in Clauses 1.7, 1.8, and 1.9 of this Schedule 2.
5.3
The Committee shall give full consideration to the matter and issue a final determination to the Director
General in respect of same. The Director General shall notify in writing the Medical Practitioner of the
determination of the Committee.
SCHEDULE 3. DISPUTE RESOLUTION PROCEDURE
1
2
DISPUTE RESOLUTION PROCEDURE
1.1
Routine disputes should be capable of being resolved without recourse to a formal Dispute Resolution
Procedure.
1.2
The parties to this Agreement shall use their best endeavours to communicate and co-operate with each
other with a view to resolving in good faith any matters in dispute arising between them on the
operation of this Agreement.
SCOPE OF SCHEDULE 3
2.1
3
The procedure set out in this Schedule 3 shall apply to the operation of this Agreement as it impacts on
the rights and obligations of the parties thereto only and shall not apply to;
2.1.1
Any matter the subject of an investigation in accordance with Schedule 2.
2.1.2
Any matter in respect of which any part of this process has already been invoked or for which
judicial proceedings are being pursued by either party.
2.1.3
Any matter in respect of which a mediation process, third party arbitration or judicial
proceedings are being pursued by either party.
2.1.4
Any matter that gives rise to a dispute which:
a)
Has already been resolved through the reaching of a collective agreement or;
b)
The parties have previously been involved in a mediation process where an agreed
outcome was reached, or
c)
Either Party has had the matter in dispute determined through a third party arbitration
or through judicial proceedings
2.1.5
Any matter that was not brought in to this process within three years of the matter in dispute
arising.
2.1.6
Any matter that gives rise to a dispute over the interpretation of contractual matters under this
Agreement. Such matters shall be dealt with under the Framework Agreement between the
Department of Health, HSE and the IMO dated June 2014.
REVIEW OF MATTERS IN DISPUTE
3.1
Where a dispute arises that is comprehended by the Scope of this Dispute Resolution Procedure the
matter in question will be dealt with in accordance with a standard operating procedure agreed
between the HSE and the IMO.
3.2
Every effort shall be made by the parties to resolve the matter in dispute, at the lowest level of
complexity and in the first instance through, the informal process and thereby obviating the need to
have recourse to the formal dispute resolution procedure described hereunder.
3.3
Where informal attempts have not resolved the matter in dispute, details should be submitted in
writing by the Medical Practitioner or where applicable his/her Representative Body to the HSE Senior
Manager responsible for the particular area or service. The HSE Senior Manager responsible shall,
within four weeks from receipt of correspondence, review the matter in dispute and issue a response
in writing to the Medical Practitioner and, where applicable, his/her Representative Body. Where the
HSE Senior Manager is unable to complete this review within four weeks, he/she shall, before the end
of the specified four weeks, write to the Medical Practitioner and, where applicable, his/her
Representative Body explaining the reason for the delay (which must be reasonable) and indicating
when the review will be completed. Such delays shall not be for a period greater than four weeks, save
where the parties agree otherwise.
4
ESCALATION PROCEDURE
4.1
Where in the opinion of the Medical Practitioner the matter in dispute has not been resolved to his/her
satisfaction, the Medical Practitioner may then submit comprehensive details of his/her complaint or
dispute to the Officer nominated specifically under the escalation procedure to manage such matters,
hereinafter referred to as the “Delegated Officer”. The Delegated Officer shall in all instances be senior
in grade to the HSE Senior Manager who carried out the initial formal review of the matter in dispute
and shall not have had any direct prior involvement in the matter in dispute. The Referral to the
Delegated Officer shall be accompanied by all relevant documentation including copies of all
correspondence between the Medical Practitioner and, where applicable, his/her Representative Body
and the HSE in relation to the matter in dispute including those outlined in Clause 3 of this Schedule 3.
4.2
Delegated Officers are responsible for the following areas:
4.3
5
-
Area 1 -
Donegal, Sligo, Leitrim, Cavan, Monaghan
-
Area 2 -
Galway, Roscommon, Mayo
-
Area 3 -
Clare, Limerick, North Tipperary
-
Area 4 -
Kerry, Cork
-
Area 5 -
South Tipperary, Carlow, Kilkenny, Waterford, Wexford
-
Area 6 -
East Wicklow, Dun Laoghaire, Dublin South East
-
Area 7 -
Kildare, West Wicklow, Dublin South West, Dublin South City, Dublin West
-
Area 8 -
Laois, Offaly, Longford, Westmeath, Louth, Meath
-
Area 9 -
Dublin North, Dublin Central, Dublin North West
-
Primary Care Reimbursement Services
-
National Contracts Office
Delegated Officers are nominated by the National Director Primary Care Division and Delegated Officers
will be notified to the IMO at least on an annual basis.
THE DELEGATED OFFICER
5.1
The Delegated Officer shall, within seven days of the matter in dispute being received by him/her,
confirm in writing to both parties, that his/her review has commenced. The Delegated Officer may
interview the Medical Practitioner, HSE staff or other individuals as appropriate. The Delegated Officer
shall notify the Medical Practitioner and, where applicable, his/her Representative Body and the HSE
Officer(s) of his/her determination generally within four weeks from the date that the Delegated Officer
informed the parties that the review has commenced which shall in all cases be within seven days of the
matter in dispute being referred to him/her. Where the Delegated Officer is unable to complete this
review within this timeframe, he/she shall, before the expiration of the four week period, write to the
Medical Practitioner, and, where applicable, his/her Representative Body explaining the reason for the
delay (which must be reasonable) and indicating when the review will be completed.
5.2
If a matter in dispute is resolved by the Delegated Officer, a written memorandum, (a “Memorandum of
Resolution”), shall be prepared jointly and signed by both the HSE and the Medical Practitioner or,
where applicable, his/her Representative Body. The Memorandum of Resolution will confirm that the
resolution is in full and final settlement of the dispute, will record all matters in issue and all material
factual details of the dispute and the terms of resolution. A copy of the Memorandum of Resolution will
be supplied to both the Medical Practitioner and, where applicable, his/her Representative Body and
the relevant HSE Officer(s).
6
THIRD PARTY DISPUTE RESOLUTION
6.1
6.2
7
REFERRAL TO THIRD PARTY
6.1.1
If the matter in dispute has not been resolved in accordance with the procedures outlined in
Clauses 1, 2, 3, 4 and 5 of this Schedule 3 the Medical Practitioner or, where applicable, his/her
Representative Body may refer the dispute to an agreed Independent Disputes Resolution
Panel Member (the “Panel Member”) by way of a written referral (the “Referral to Third
Party”).
6.1.2
The Panel Member will be appointed in any given case from a panel agreed between the HSE
and the IMO unless the Medical Practitioner wishes to nominate an alternative third party to
review the matter in dispute. Any such alternative appointment will be agreed between the
Medical Practitioner and the HSE and the referral to Third Party process outlined in sub-clauses
6.2.1, 6.2.2 of this Schedule 3 shall also apply in such instances.
6.1.3
The panel will be maintained by the HSE and any changes to its composition shall only be made
by agreement between the HSE and the IMO.
THIRD PARTY CORRESPONDENCE
6.2.1
The Referral to Third Party by the Medical Practitioner or, where applicable, his/her
Representative Body shall be accompanied by all relevant documentation including copies of all
correspondence between the Medical Practitioner and, where applicable, his/her
Representative Body and the HSE in relation to the matter in dispute, all of which shall already
have been furnished to the Delegated Officer as part of the previous stage in this dispute
resolution process. A copy of the Referral to Third Party and accompanying documentation
shall be sent to the HSE at the same time that the referral is lodged.
6.2.2
The HSE shall be entitled to respond to the Medical Practitioner’s referral to the Panel Member.
The HSE shall forward to the Medical Practitioner and, where applicable, his/her Representative
Body, a copy of its response to the Panel Member on the same date.
DISPUTE RESOLUTION PROCEEDINGS
7.1
The Panel Member will, when required, be available for at least two full days per month to hear disputes
that have been referred to him/her.
7.1.1
The reasonable fees, costs and expenses of the Panel Member shall be borne by the HSE. For
the avoidance of doubt, in all other respects, each party shall bear its own costs and expenses
of its participation in the Third Party Dispute Resolution process.
7.1.2
In the interest of cost effectiveness the proceedings will be hosted on HSE premises. In the
event that a HSE premises is not available to host proceedings the HSE shall be responsible for
sourcing suitable alternative facilities and the costs of same shall be borne by the HSE.
7.1.3
Disputes shall be disposed of by way of hearing, unless otherwise determined by the Panel
Member following consultation with both Parties, and the Panel Member shall consider all
written and oral submissions made to him/her by the parties and having considered all such
submissions the panel member shall endeavour to issue a written recommendation to both
sides within six weeks from commencement of the review of the matter in dispute by the Panel
Member.
7.1.4
The recommendation of the Panel Member shall be accepted by both parties to the dispute
except where either side complains that the decision goes outside the terms of the Agreement.
7.1.5
In circumstances where either side complains that the decision goes outside the terms of the
Agreement either party may, within four weeks of receipt of the Panel Member’s
recommendation, apply to the President of the Institute of Chartered Arbitrators to appoint an
Arbitrator (not being a Panel Member) to determine whether the recommendation of the Panel
Member goes outside the terms of the Agreement. The findings of the Arbitrator shall be
binding in this regard. The Arbitrator shall endeavour to deliver such findings within six weeks
of referral.
7.2
7.3
7.1.6
Where the appointed arbitrator has determined that the Panel Member has gone outside the
terms of the Agreement then the matter in dispute shall be addressed through the Framework
Agreement as outlined at Clause 2.1.6.
7.1.7
Where the finding of the Arbitrator is that the Panel Member’s recommendation does not go
outside the terms of the agreement then the Panel Member’s recommendations on the matter
in dispute shall be accepted by both parties.
7.1.8
The reasonable fees, costs and expenses of the Arbitrator shall be borne by the HSE.
REVIEW OF DISPUTE RESOLUTION PROCEEDINGS
7.2.1
The operation of the Dispute Resolution Procedures will be reviewed annually under the
Framework Agreement.
7.2.2
The terms of this Schedule 3 shall be subject to alteration, following a review of its operation in
accordance with Clause 21 of this Agreement.
All parties agree to utilise the dispute resolution mechanism for all disputes which fall within the scope
of the Agreement and the parties will only resort to litigation having exhausted the dispute resolution
procedures.
APPENDIX 1: PERIODIC ASSESSMENTS
1
DEFINITION OF PERIODIC ASSESSMENTS
1.1
Periodic Assessments are age based preventive checks focused on health and wellbeing and
prevention of disease. The Medical Practitioner shall take an active approach toward promoting
health and preventing disease through the provision of Periodic Assessments to Child Patients. In
accordance with the provisions of this Agreement the Medical Practitioner shall;
1.1.1
2
Record the age, gender, weight and height of Child Patients aged two and five years, and plot
same on a centile chart. The Medical Practitioner shall also take appropriate follow-up action,
including where appropriate, provision of health promotion advice, brief intervention and
support, or referral to specialist services. During the assessments, the Medical Practitioner
shall, where practicable, record whether a child lives in a smoke free household or not with a
view to providing advice on smoking cessation.
SUBMISSION OF DATASET
2.1
The Medical Practitioner shall:
2.1.1
3
4
Submit an agreed dataset to the HSE annually relating to periodic assessments carried out
for Child Patients aged two and five years as outlined at Clause 3 hereunder.
OUTLINE OF SAMPLE DATASET FOR PERIODIC ASSESSMENTS (AGE 2 AND 5 YEARS)
PAYMENT RATES
4.1
Payments for the delivery of Periodic Assessments to relevant Child Patients shall be made in
accordance with the provisions of Clause 17 and Schedule 1 of this Agreement.
APPENDIX 2
CYCLE OF CARE FOR CHILD PATIENTS UNDER 6 YEARS WITH A DIAGNOSIS OF ASTHMA
1
DEFINITION OF ASTHMA
1.1
2
2.2
Establish and maintain a patient register and reminder system for their Child Patients aged
between two and five years inclusive with a confirmed diagnosis of asthma, hereafter referred
as registered Child Patients;
1.1.3
Implement a defined Cycle of Care for their registered Child Patients as set out in this Appendix
2.
The register and reminder system will:
2.1.1
Include a list of the Medical Practitioner’s known registered Child Patients;
2.1.2
Include the registered Child Patient’s name, contact details, date of birth, gender, HSE identifier
for the registered Child Patient,
2.1.3
Be kept active and updated.
The register can be in electronic or paper-based format.
THE CYCLE OF CARE
3.1
4
1.1.2
REGISTER
2.1
3
Asthma is a disease usually characterised by chronic airway inflammation. Asthma is a clinical
diagnosis defined by a combination of typical symptoms such as cough wheeze, episodic
breathlessness and chest tightness often associated with a personal or family history of atopy/asthma
accompanied by reversibility with appropriate asthma medications. In accordance with the provisions
of this Agreement the Medical Practitioner shall:
While registered Child Patients may require frequent monitoring and review as clinically indicated, the
asthma Cycle of Care at a minimum will include one initial consultation after the registered Child Patient
has reached the age of two years; a review consultation after three months of diagnosis; and an annual
review thereafter until the registered Child Patient has reached six years of age. The assessment and
management is set out hereunder.
ASTHMA CONSULTATION
4.1
Each asthma consultation will include the following:
4.1.1
Documented diagnosis and assessment of the registered Child Patient’s level of asthma control
and severity of asthma;
4.1.2
Review of the registered Child Patient’s use of, and access to, asthma related medication and
devices;
4.1.3
Recording the smoking status of the household and provision of brief intervention if
appropriate;
4.1.4
Recording if the influenza vaccine was offered to registered Child Patients with moderate to
severe asthma;
4.1.5
Provision to the registered Child Patient/Parent or Guardian of the registered Child Patient of
education about their asthma and a written asthma action plan (if the Parent or Guardian of
the registered Child Patient is unable to use a written asthma action plan, then discussion with
the Parent or Guardian of other methods of providing an asthma action plan, and note the
discussion in the registered Child Patient’s medical record);
4.1.6
Provision of asthma self-management education to the Parent or Guardian of the registered
Child Patient;
4.1.7
Where applicable, a review of the written or documented asthma action plan; and
4.1.8
Scheduling of next review.
5
OUTLINE OF SAMPLE DATASET FOR ASTHMA CYCLE OF CARE
6
SUBMISSION OF DATASET
6.1
7
The Medical Practitioner shall:
6.1.1
Submit an agreed dataset to the HSE annually relating to registered Child Patients.
6.1.2
Provide evidence of its patient register and reminder system and the completion of the cycle of
care for each registered Child Patient, subject to data protection provisions.
PAYMENT RATES
7.1
Payments for the delivery of services to registered Child Patients under this Cycle of Care shall be made
in accordance with the provisions of Clause 17 and Schedule 1 of this Agreement.